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Diabetes overtreatment in dementia — SCE Geriatric Medicine MCQ

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HardEndocrine medicineDiabetes overtreatment in dementiaSCE Geriatric Medicine

An 85-year-old man with moderate dementia has repeated admissions after forgetting insulin and meals. HbA1c is 52 mmol/mol, he has two severe hypoglycaemic episodes and his wife is exhausted. He takes basal-bolus insulin, gliclazide, ramipril and atorvastatin. What is the most appropriate management?

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Correct answer: C — Simplify diabetes treatment and prioritise avoidance of hypoglycaemia with carer and community support

In dementia and frailty, hypoglycaemia avoidance and regimen simplicity are often more important than tight glycaemic targets. Basal-bolus insulin plus sulfonylurea is high burden and high risk when meals and administration are unreliable. Carer strain and community nursing support are part of safe diabetes management. The pearl is that treatment complexity can be the main disease complication in cognitive impairment.

Reference: NICE NG28; NICE NG97; NICE NG56